I use to say that too, that people weren’t victims, that they have control over the way their lives turn out. But, after spending many years working in low income housing communities, and hearing children discuss which gangs their daddies were in, which color bandana they wore, watching their daddies and brothers and uncles get shot and killed, I will never again say this. One little 8 year old boy cried on my shoulder and asked me to pray for his momma cause he found his little sister dead in the bed. He didn’t know that Jesus could help him too. He thought Jesus was just for those other people who didn’t live where he lived. He will grow up to be a man, maybe living in the same area, maybe with the same experiences as his father. Sometimes the trauma we experience, which I have no real understanding of, undeniably shapes our futures. Some can escape the damage, but for others, its nearly impossible. I learned an important lesson. I will hold my tongue before I speak. I will search for the pain behind another’s words and actions. I will love and accept, even if I don’t understand. I have not experienced much in my life, and chances are, neither have you.
The baby goats got to come home a little early! They were due to arrive in May, but I begged and pleaded. Finally, the breeder decided let us have them a week early. We picked them up and drove home with two goats in our truck bed. It was quite the funny experience; however, I realize this is probably a totally normal and boring experience for “actual” farmers. They seem to be adjusting really well to their new home. The first night they cried every time we walked away. Their cries were MUCH louder than I expected. All our neighbors now know when snuck goats into the city limit. Oops!
We put up a temporary shelter for them with some pallets since our mini barn isn’t built yet. (Hopefully, its going up within the next week or so.) Finally, to get them to be quiet, I propped up some things in front of their little shed so they would be totally enclosed. They liked this set up MUCH better and were quiet the rest of their first night. Today, they are playing, munching on all the fresh tall grass in their pen, and looking very happy. Just a few hours after their arrival, they seem to be settling in perfectly!
|H.R. 2527: Vaccinate All Children Act of 2019|
|Briefly describe the issue:
Reinhart (2020) stated that only 84% of people in U.S. say childhood vaccinations are important, down from 94% in 2001. According to GovTrack (2019), the recent trend of decreasing vaccination rates caused the 2019 measles rate to be higher than it had been in decades and creates the opportunity for other preventable outbreaks. All 50 states currently require vaccinations for children to attend school; however, 45 states allow religious or personal exemptions (GovTrack, 2019). Only five states currently allow no exemptions except for medical reasons. The issue is whether or not the federal government should require all states to remove the religious and personal exemption options from vaccination requirements, or should it be left to the state as is the status quo.
|1. Identify the Pros||Identify the Cons|
|Proponents of federal intervention on state vaccination requirements argue that with surging rates of diseases easily prevented by vaccines, a public health crisis is being caused by the lack of strong public policy requirements (GovTrack, 2019). Pierik (2017) discussed how public questioning of vaccines leads to a decline in vaccination rates and ultimately culminates infectious disease outbreaks such as the measles outbreak in 2015, which was the first major measles outbreak in over a decade and spread throughout the US and Mexico. Shrivastava, Shrivastava and Ramasamy (2016) wrote how the outbreak had reiterated the importance of sustaining a high level of immunization coverage for vaccine-preventable disease. Infectious diseases were once the leading cause of death, but, since the creation and implementation of vaccines, they currently rank eighth (Anderson, 2015).
Childhood vaccination rates are lower in states with more permissive exemption policies (Garnier, Nedell, Omer, & Bansal, 2020). Garnier, Nedell, Omer, and Bansal’s study (2020) shows that non-medical exemption (NME) rates are negatively associated with vaccination rates for major childhood vaccinations for which mandates exist. Also, their study shows that eliminating NMEs is an effective way to reduce exemption rates overall.
Proponents insist the federal government can protect society against the threat of preventable, infectious disease by removing the state’s ability to allow religious and personal exemptions from immunization regulations (Pierik, 2017).
|Opponents of federal intervention on state vaccine requirements argue that such federal mandates are an infringement on personal liberty, and the removal of a religious exemption violates the First Amendment’s freedom of religion (GovTrack, 2019). Opponents are often members of religious groups who argue that vaccinations interfere with divine providence (Pierik, 2017). Pierik (2017) described a growing anti-vaccination movement which argues that the dangers of vaccinations outweigh the benefits.
According to Dredze & Broniatowski (2015), common reasons parents give for refusing vaccinations are: fear that vaccines cause autism, concerns over toxins, beliefs about the benefits of measles to the immune system, distrust of government, distrust of pharmaceutical companies, and preference for a natural lifestyle. According to Anderson (2015), some believe vaccinating children denies that child free choice, and that the risks of infection are minimal due to advances in medicine. Another ethical concern for some is the fact that certain vaccines are grown in cell strains derived from an aborted fetus (McKenna, 2017).
Centers for Disease Control and Prevention (CDC) (2020) lists several incidences where vaccinations have caused harm such as the 1955 polio vaccine given to the public containing live virus and caused 250 cases of polio, the 1955-1963 simian virus 40 (SV40) contaminated polio vaccines, vaccine induced Guillain-Barré Syndrome associated with several vaccines, the 2009 H1N1 influenza vaccine that was associated with a high incidence of narcolepsy. According to the CDC (2020), there is a concern that vaccinations may have the ability to cause cancer and, although studies are reassuring, this idea has not been disproven.
|2. Summarize the bill:
H.R. 2527: Vaccinate All Children Act of 2019 is a bill currently under consideration (GovTrack, 2019). Its passage would prohibit the Department of Health and Human Services from awarding grants to public entities of a state for preventive health service programs unless the state institutes vaccination requirements on all its public schools. The bill would force all states to require each student in public elementary or secondary school to be vaccinated in accordance with the recommendations of the Advisory Committee on Immunization Practices. According to GovTrack (2020), the only exception to this bill would be for students whose health would be endangered by vaccination in the opinion of a physician conforming to the accepted standard of medical care. The purpose of this bill is to prevent future outbreaks of contagious diseases, and it addresses the issue of whether or not federal government should remove the religious and personal exemption options from vaccination requirements (GovTrack, 2019). Variations in state vaccination regulations would be eliminated and all states would be forced to uphold the same set of federal regulations.
An example of this is in the state of Indiana which currently allows vaccine exemptions for religious reasons. The state will no longer be permitted to allow these exemptions if the bill passes. (National Conference of State Legislators, 2020). According to GovTrack (2019), the bill is in the first stage of the legislative process and is expected to be considered by committee before being sent on to the House or Senate. It is possible that even if this legislation does not pass Congress, a federal agency could enact a similar change on a national level. The Food and Drug Administration’s commissioner recently suggested that his agency might step in to introduce a federal requirement if states do not enact stricter guidelines (GovTrack, 2019).
|3. Discuss how the issue and the bill affects healthcare providers, specifically ARNPs:
H.R. 2527: Vaccinate All Children Act of 2019 is an important bill to ARNPs because they are on the front lines of promoting and administering immunizations. Whether or not the federal government should force states to eliminate vaccination exemptions is an ongoing, controversial issue, and ARNPs will encounter parents and patients with strong opposing and proposing opinions. According to William (2019), an increasing number of children in the United States are not receiving some or any vaccinations. The CDC reported that the percentage of unvaccinated children younger than 2 years has quadrupled since 2001 (William, 2019).
Balestra (2016) discusses that ARNPs, especially those working in the pediatric and family specialties, should ensure all parents are informed about both the risks of vaccine-preventable diseases and the risks and benefits of immunizations. ARNPs are required by law to discuss vaccine-associated adverse reactions and the provision of Vaccine Information Statements (VISs). The National Childhood Vaccine Injury Act requires that all healthcare providers give parents a copy of VISs before administering any dose of a vaccine (Balestra, 2016).
To deal with the issue of vaccination, the APRN should first know where they stand on the issue and look to professional organizations for guidance. According to Anderson (2015), many healthcare providers also are hesitant on the topic of vaccination. Second, APRNs should decide how they will approach parents who are opposed to vaccines. Understanding the fear some parents have as they contemplate vaccinating their child and addressing specific concerns for their child with scientific data is one approach to improve immunization rates (Anderson, 2015). Third, APRNs should understand current research regarding relevant perspectives and practices regarding immunizations and be equipped to answer questions or concerns parents have about vaccinations. According to Anderson (2015), an effective intervention is to build a trustworthy relationship with the patient and parent and be transparent with information, allowing parents the opportunity to verbalize their specific concerns in a nonjudgmental environment. Fourth, the ARNP should support long-term efforts to monitor vaccine safety by reporting to the Vaccine Adverse Event Reporting System of the CDC as indicated (Anderson, 2015). Some practices are handling the issue by not treating patients who are not immunized. However, this approach is controversial as it leaves children without well-child or sick care (Kaplan, 2019).
The American Nurses Association’s (ANA) (2020) current stance is that all individuals should be immunized against vaccine-preventable diseases according to the best and most current evidence outlined by the CDC and the Advisory Committee on Immunization Practices (ACIP). However, the ANA (2020) supports exemption from immunizations for religious beliefs and medical contraindications. Therefore, ARNPs can support patients and honor requests for exemption due to religious beliefs with support from the ANA.
If the bill were to be passed, it would significantly impact ARNP practice in the 45 states that currently allow religious and personal exemptions. Standards of care in those states would need to change immediately and healthcare providers would no longer be able to provide exemptions for any other reason than medical. A concern is that APRNs would be faced with more requests for medical exemption. In California, after the removal of all exemptions except medical reasons, the number of medical exemptions increased from 0.2% to .07% (Kaplan, 2019). APRNs would need to fully understand qualifications for medical exemption and be prepared to face backlash from families continuing to refuse vaccination.
William, L., (2019). Role of the pediatric nurse practitioner in enhancing vaccination rates. AACN: Adv Critical Care, 30, 278–28. doi:10.4037/aacnacc2019992
American Nurses Association. (2020). Immunizations – ANA position statement. Retrieved from https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/immunizations/
Anderson, V., (2015). Promoting childhood immunizations. JNP: The Journal for Nurse Practitioners, 1, 1-10. doi:10.1016/j.nurpra.2014.10.016
Balestra, M. (2016). The antivaccine movement: Legal implication for nurse practitioners. The Nurse Practitioner, 41, 12-14. Retrieved from https://www.nursingcenter.com/journalarticle?Article_ID=3835347&Journal_ID=54012&Issue_ID=3835331
Centers for Disease Control and Prevention (CDC). (2020). Historical vaccine safety concerns. Retrieved from https://www.cdc.gov/vaccinesafety/concerns/concerns-history.html
Center for Disease Control and Prevention (CDC). (2019). U.S. measles cases in first five months of 2019 surpass total cases per year for past 25 years. Retrieved from https://www.cdc.gov/media/releases/2019/p0530-us-measles-2019.html
Dredze, M., & Broniatowski, D. (2015). Understanding vaccine refusal. Pediatrics for Parents, 31, 18-19. doi:10.1016/j.amepre.2015.10.002
Garnier, R., Nedell, E., Omer, S., & Bansal, S. (2020). Getting personal: How childhood vaccination policies shape the landscape of vaccine exemptions. Open Forum Infectious Diseases, 17, ofaa088, doi:10.1093/ofid/ofaa088
GovTrack. (2019). H.R. 2527: Vaccinate all children act of 2019. Retrieved from https://www.govtrack.us/congress/bills/116/hr2527/summary
Kaplan, L., (2019). Preventable diseases. The Nurse Practitioner, 44, 15-16. doi:10.1097/01.NPR.0000574660.34486.a5
McKenna, K. (2017). Use of aborted fetal tissue in vaccines and medical research obscures the value of all human life. The Linacre Quarterly. doi:10.1080/00243639.2017.1375065
National Conference of State Legislators (NCSL). (2020). States with religious and philosophical exemptions from school immunization requirements. Retrieved from https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx
Pierik R. (2017). On religious and secular exemptions: A case study of childhood vaccination waivers. Ethnicities, 17, 220–241. doi:10.1177/1468796817692629
Reinhart, R. (2020). Fewer in U.S. continue to see vaccines as important. Retrieved from https://news.gallup.com/poll/276929/fewer-continue-vaccines-important.aspx
Shrivastava, S, Shrivastava, P., & Ramasamy, J. (2016). The 2015 measles outbreak in America: Identified shortcomings and recommendations to the health authorities. Annals of African medicine, 15, 42–43. doi:10.4103/1596-3519.153986
The fence was a two day process and measures about 80x80ft. It will house the goats that are coming in May and all the chickens. There is talk about the possibility of a mini horse, but we will see how this goes first. The first day we spent measuring for the fence, digging holes and placing the corner posts, and pounding in each t-post. My dad came to help since we had never put up a farm fence. He brought my boys a four wheeler and that made their day! They’ve already combed some awesome trails through the woods behind our home and spent one entire day “muddin” as we called it when I was growing up in Kentucky! Outdoor life is the best life for a kid (and for grown-ups like me.)
Day 2 was used to install my repurposed gate and stretch the wire between each corner post. This process is definitely easier with a few extra hands. My oldest son was on the four wheeler controlling the winch to stretch the fence as tight as possible. The fence looks amazing a pretty much disappears into the landscape of our yard. I never knew I could be so excited about a fence! This means it’s almost time for the baby animals to arrive! It’s been a dream to have a little land we could spend our lives on and this place is just that!
This weekend we plan to put in our garden and get the corner posts in the ground for the mini barn going inside the fenced area. Next week, we hope to start on the barn! I’ll post updates as we go along!
We have so many beautiful pines on our property behind our home, and they were a mess! The kids jumped in, and we spent a couple days cutting out the lower branches and dead limbs. See my husband with the saw in the bottom right photo?
It looks like a park back there and its my new favorite spot in the yard. I love when pines umbrella over head giving you the richest forest-y smell in the world!
Beyond the tree line are some gorgeous, VERY OLD trees we wanted to play in. We cleaned it up a bit and found the perfect tree for climbing! Still trying to determine what type of tree it is. Possibly sassafras? The largest sassafras in the world is in Owensboro, KY, which is a short drive from us and thought to be at least 300 years old. So, this one might be a few hundred years old too!
Below is the future home of the fencing and shed for the baby goats arriving in May!
If you are curious about our new home here in Indiana, here it is! Also, this is a great photo of the amazing sycamore tree!
Come back soon for fencing and shed progress for the cute little goats!